The Rumack-Matthew nomogram for acute acetaminophen overdoses, and the Done nomogram for acute salicylate overdoses, both suggest the degree of toxicity that may be expected from the untreated poisoning. We've produced downloadable/modifiable GIF versions of both, using both SI and US units.

Feel free to use/adapt these to enhance your own web sites, databases, information systems, etc. In the near future, we'll be providing routines that will plot serum levels dynamically; you won't need third-party applications, or have to go to a reference text to roughly plot your values.

Of course, some provisos apply. These nomograms are only for the acute overdose, and even in this setting, they are not perfect. More on this in the actual article.

Emergency Department Information Systems - solutions and vendors

December 17, 2006

Emergency Department Information Systems are incredibly complex. A fully-fledged solution registers and triages the patient, then tracks him or her, via customizable status boards that either display the entire department or the patient list for a particular provider, on any of a number of possible devices. It gives instant access to the patient's electronic medical record, and allows bed-side or remote charting, order entry, and decision support. It advises you when your patients' results are back, and allows immediate access to that lab value, an ECG, or an MRI. It pages and faxes, writes prescriptions, handles billings, ensures necessary record-keeping occurs. Finally, it tracks results, and can report on every aspect of the care provided.

A tall order; in the accompanying article we list nine vendors and the solutions they claim deliver the goods.

Emergency Department Information System - Request for Proposal

July 11, 2006

Requests for Proposals are exhaustive documents, submitted to a few targeted vendors, felt likely to be able to meet a specific corporate need. In this example, for an Emergency Department Information System (EDIS).

An RFP lists all of the identified needs that the proposed solution should cover, from the macroscopic (i.e. for an EDIS, is there a physician charting module?) to the microscopic (is data from Nellcor N-20 oximeters directly copied to the database?) No desired item, no matter how small should be missed. As such, development of an RFP is an arduous process; vendors require significant time to analyze each question, respond, elaborate as necessary. Finally, the scoring of these responses must be formally documented, in case some vendor later feels they were unfairly slighted.

Recommendations for the Selection and Implementation of an Emergency Department Information System

July 4, 2006

Emergency medicine is a potential minefield for automation. Emergency Department Information Systems (EDIS) can aid or impair the delivery of patient care, can save lives or end them.

Health Care Information Systems are frequently compared with air traffic control: if such a critical industry can cut wait times with fewer staff, improve customer satisfaction, and above all realize significant gains in reliability and safety, then surely something as simple as a small Emergency Department can do the same. But the analogy soon falls apart ...

Second, a Request for Proposal as submitted (in somewhat revised form) to multiple EDIS vendors. This is part of the normal selection process. Vendors respond to all items, whether they support them fully, partially, or intend to. These responses form part of the initial EDIS evaluation process. You'll find that what we do and what we want is listed in exhaustive detail.

Volume 11, Issue 11 of Academic Emergency Medicine is devoted entirely to Emergency Department Information Systems. Some of the articles are brilliant, others slow plodding; the entire issue is densely packed with information. It's available free of charge at www.aemj.org/content/vol11/issue11/.